Welcoming the Worst: Breathing Life into your Trauma Resuscitation

Being one of the few pediatric emergency departments to care for pediatric trauma patients up to age 18, St. Louis Children’s Hospital sees more than its fair share of action. While this exposure catapulted my experience, confidence, and clinical skills, hearing the trauma pager beep during my first few months as an attending evoked a Pavlovian response only completely summarized as nail-biting, diaphoretic anxiety. While the butterflies still flutter away to this day when that pager goes off, I learned to “welcome the worst” into the ED by taking several fast and easy steps to anticipate a trauma resuscitation.

The following are my personal strategies in the 5-10 minutes we often have before EMS arrive to begin a resuscitation before the patient arrives.

1. Prepare myself: Don appropriate PPE an be physically present in the trauma bay before the patient arrives. Scan a PALS or other type of resuscitation card/sheet to bring focus away from the rest of the busy ED and to the potential serious injury soon to arrive. If enough information about the patient is known, mentally run through the most likely workup and consider entering preliminary orders into the electronic ordering system for quick review and signature finalization after patient evaluation. Consider what RSI medications and code drug dosages to use.

2. Prepare my nurses: Review what en-route details are known about the patient. Discuss what fluid resuscitation may be needed an consider prepping a pressure bag or rapid infuser. Discuss how many lines of access to prepare for and what labs are likely to be needed.

4. Prepare my radiology techs: Discuss any images the patient may have already had (if transferred from another hospital) or what imaging will likely be ordered.

5. Know my team: Know the name of everyone in the room and what role they are playing to facilitate closed loop communication. If the patient is expected to have brain, orthopedic, or facial injuries – alert subspecialty surgeons to the patient’s impending arrival.

6. Know my trauma bay: Be familiar with where the doppler, chest tubes, O negative blood, and other lesser used supplies are that may be needed without delay.

These small steps in discussing the patient and anticipating a work up in advance solidify an ED team and support efficiency.